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目的:探讨儿童咽部等离子手术后重度咽瘢痕狭窄的病因及治疗。方法:回顾性分析2012-06-2016-07期间住院治疗的5例等离子术后重度咽狭窄患儿(单纯鼻咽狭窄2例,鼻咽和口咽联合狭窄3例)的临床资料,5例患儿分别采用瘢痕切除、临近黏膜瓣或游离植皮修复创面、口咽狭窄横切纵缝、鼻咽部放置支架6个月以上等方式治疗。疗效评估:术前和术后的鼻塞和经鼻呼吸困难、张口呼吸、鼻涕多不易擤出、闭塞性鼻音、睡眠打鼾、睡眠多动不安、嗅觉减退、吞咽困难等主观症状评分变化,以及狭窄咽腔扩大情况。结果:5例患儿随访7~46个月,术后咽气道最大直径扩大到1.5~2.0cm,症状评分明显改善,无鼻咽反流及开放性鼻音。结论:联合不同手术扩大咽腔,创面争取黏膜化,同时放置鼻咽支撑物,是治疗儿童重度咽狭窄较理想的方法。
Objective: To investigate the etiology and treatment of severe pharyngeal scar stenosis after pharyngeal plasma surgery in children. Methods: The clinical data of 5 patients with severe pharyngeal stenosis (simple nasopharyngeal stenosis in 2 cases, nasopharyngeal and oropharyngeal stenosis in 3 cases) after hospitalization during 2012-06-2016-07 were retrospectively analyzed. The clinical data of 5 cases Children were treated with scar excision, wound repair near the mucosal flap or free skin graft, oropharyngeal stenosis transverse septum, nasopharyngeal stent placement for 6 months or more. Efficacy assessment: Preoperative and postoperative nasal obstruction and nasal breathing difficulties, mouth breathing, nose and more difficult to come out, nasal obstruction, sleep snoring, restless sleep, loss of sense of smell, difficulty swallowing subjective symptom score changes, and stenosis Pharyngeal enlargement. Results: Five children were followed up for 7 to 46 months. The maximal diameter of the pharyngeal airway was enlarged to 1.5 ~ 2.0cm after operation. The symptom score was significantly improved without nasopharyngeal reflux and open nasal tone. Conclusion: The combination of different operations to expand the pharynx, mucosa for mucosal wound, while placing the nasopharyngeal support, the treatment of severe pharyngeal stenosis is a more ideal method.